Acute concomitant pulmonary artery and aortic dissection with rupture

Abstract

Pulmonary artery (PA) dissection is uncommon and may lead to rupture and sudden death if encountered. A 63-year-old man presented to our emergency room with episodic left chest pain radiating to the back followed by shortness of breath. A 64-row multidetector computed tomography (MDCT) revealed ruptured dissection of the PA and the aorta with hemopericardium, hemomediastinum, and prominent extravasated blood along the central bronchovascular bundles of both lungs. The patient experienced cardiogenic shock immediately following CT study and died after resuscitation. Concomitant PA and aortic dissection with rupture is extremely rare with the pathogenesis remaining investigated. MDCT proves to be a powerful tool in its diagnosis for a timely surgical repair if the patient could survive to have the operation.

Two- and Three-Dimensional Transesophageal Echocardiographic Detection of Aortic Dissection Rupture With Extension of Dissection Into the Pulmonary Artery

“… 14 , 15 The mechanism of combined AO and PA dissection was not clear in 1 patient who presented with cardiogenic shock from PA rupture into the mediastinum. 16 …”

“…Combined aortic (AO) and main pulmonary artery (MPA) dissection is a very rare and highly lethal entity, with only 16 cases reported in the literature. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 We report an elderly patient in whom two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) performed intraoperatively showed rupture of the AO dissection false lumen into the pulmonary artery (PA) with the dissection flaps in the PA clearly noted to be continuous with and extending from the AO false lumen. Thus, we were able to make a definitive diagnosis of PA dissection resulting from AO dissection rupture by TEE in this patient.…”

Idiopathic pulmonary artery dissection: a case report

“…Although Marfan's syndrome is often associated with aortic dissection, so far there is only one reported case of PA dissection in a patient with Marfan's syndrome [1]. Interestingly, two patients were reported to have aortic and PA dissection which was not associated with Marfan's syndrome [18,19]. There are three previous cases that have been reported as idiopathic dissection and were hypothesized to be secondary to some inflammatory or non-specified cause [13].…”

Complications Leading to Sudden Cardiac Death in Pulmonary Arterial Hypertension

“…67 In contrast to aortic dissection, the false lumen in PAD tend to rupture rather than to develop a re-entry site. 68 PAR may occur into the pericardium [70][71][72] or pleural cavity, leading to sudden death, and usually involves the site of maximal diameter of the pulmonary artery.…”